| NPI | 1902344278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP1043124) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R224563) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC CACII200001280) | |
| 163W00000X Registered Nurse (Licence: DC RN1043124) | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2025-09-16 |